Adenosine-Induced Stress Myocardial Perfusion Imaging Using Dual-Source Cardiac Computed Tomography

• Published in: Journal of the American College of Cardiology Vol. 54; no. 12; pp. 1072 - 1084
• Main Authors: Blankstein, Ron, Shturman, Leon D., Rogers, Ian S., Rocha-Filho, Jose A., Okada, David R., Sarwar, Ammar, Soni, Anand V., Bezerra, Hiram, Ghoshhajra, Brian B., Petranovic, Milena, Loureiro, Ricardo, Feuchtner, Gudrun, Gewirtz, Henry, Hoffmann, Udo, Mamuya, Wilfred S., Brady, Thomas J., Cury, Ricardo C.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.09.2009; Elsevier; Elsevier Limited
• Subjects: Adenosine - administration & dosage; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cholesterol; computed tomography; Coronary Angiography - methods; Coronary Circulation; coronary disease; Coronary Stenosis - diagnosis; Coronary vessels; Exercise Test - methods; Female; Heart attacks; Humans; imaging; infarction; Injections, Intra-Arterial; Internal Medicine; ischemia; Male; Medical imaging; Medical sciences; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Tomography; Tomography, Emission-Computed, Single-Photon - methods; Tomography, X-Ray Computed - methods; Vasodilator Agents - administration & dosage; computed tomography; DSCT; DE; MRI; CAD; MPI; infarction; MPHR; imaging; SPECT; ischemia; coronary disease; CT; CTA; CTP; coronary artery disease; maximal predicted heart rate; magnetic resonance imaging; myocardial perfusion imaging; delayed enhancement; computed tomography angiography; dual-source computed tomography; computed tomography perfusion; single-photon emission computed tomography; Heart; Adenosine; Radiodiagnosis; Perfusion imaging; Myocardium; Medical imagery; Computerized axial tomography; Circulatory system; Cardiology; Source; Stress
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2009.06.014

This study sought to determine the feasibility of performing a comprehensive cardiac computed tomographic (CT) examination incorporating stress and rest myocardial perfusion imaging together with coronary computed tomography angiography (CTA). Although cardiac CT can identify coronary stenosis, very little data exist on the ability to detect stress-induced myocardial perfusion defects in humans. Thirty-four patients who had a nuclear stress test and invasive angiography were included in the study. Dual-source computed tomography (DSCT) was performed as follows: 1) stress CT: contrast-enhanced scan during adenosine infusion; 2) rest CT: contrast-enhanced scan using prospective triggering; and 3) delayed scan: acquired 7 min after rest CT. Images for CTA, computed tomography perfusion (CTP), and single-photon emission computed tomography (SPECT) were each read by 2 independent blinded readers. The DSCT protocol was successfully completed for 33 of 34 subjects (average age 61.4 ± 10.7 years; 82% male; body mass index 30.4 ± 5 kg/m2) with an average radiation dose of 12.7 mSv. On a per-vessel basis, CTP alone had a sensitivity of 79% and a specificity of 80% for the detection of stenosis ≥50%, whereas SPECT myocardial perfusion imaging had a sensitivity of 67% and a specificity of 83%. For the detection of vessels with ≥50% stenosis with a corresponding SPECT perfusion abnormality, CTP had a sensitivity of 93% and a specificity of 74%. The CTA during adenosine infusion had a per-vessel sensitivity of 96%, specificity of 73%, and negative predictive value of 98% for the detection of stenosis ≥70%. Adenosine stress CT can identify stress-induced myocardial perfusion defects with diagnostic accuracy comparable to SPECT, with similar radiation dose and with the advantage of providing information on coronary stenosis.